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As we start the new year, hopefully wilderness activities will resume as COVID-19 vaccines reach the citizens of the world. While we’re waiting, we can reflect upon great adventures of the past and what they teach about preparation, performance, and personal and collective courage. This article focuses on the Lewis and Clark Expedition—not only was it one of the greatest adventures in US history, but also it bears a personal connection to my recent move from the Philadelphia area to Oregon. We’re taught in history classes about the expedition. Captains Meriwether Lewis and William Clark, at the behest of President Thomas Jefferson, were charged with charting a transcontinental route to the west coast. This “Corps of Discovery,” 33 courageous, adventurous men (and one woman, Sacagawea) embarked on this journey into unknown terrain. The Corps started from St. Louis in May 1804 and reached the Pacific Ocean in November 1805, wintering over near the mouth of the Columbia River, then traveling back east from March to September 1806, for a total of 8000 miles.

Lewis and Clark didn’t employ an expedition doctor for their arduous journey but did all the doctoring themselves, successfully managing the medical maladies of expedition members as well as those of native tribes they encountered. They lost only one man on the trip (to what may have been a ruptured appendix or other organ or aneurysm). Both men had medical experience from their military time, and Lewis’ mother was an herbalist who passed on her knowledge. The medicines and medical supplies for the expedition were purchased in Philadelphia, which had the nation’s first medical school and hospital.

Wilderness medicine practitioners prepare our expedition medical kits based on location of travel, terrain, activity type, anticipated physical and medical hazards, etc. Lewis and Clark had to choose their supplies based on similar factors, but with so many unknowns. What did they expect and what did they pack? The pharmaceutical armamentarium was limited at that time and seemed quite barbaric: the prevailing philosophy was that diseases were caused by imbalances in the body or because the patient was “bilious” (excess bile was thought to be the cause of many disorders); the way to remove the “bad” things was with bleeding, vomiting, sweating, and purging. Below is a list of expected conditions, medications, and medical supplies packed for the expedition after consultation by Lewis and Clark with the infamous Dr. Benjamin Rush and other physicians. It’s amusing to consider that the total cost for the expedition’s medical kit was $90.60!

Invoice for medical supplies for Lewis and Clark Expedition
Source: Discovering Lewis & Clark

Ague/intermittent fever (malaria)

Powdered cinchona bark/Peruvian Bark (Conchona officinalis L.)

This bulky bark was taken for fevers suffered from mosquito bites, although the correlation between mosquitoes and malaria had not been made yet. Quinine came much later.

Camphor oil

Used to induce sweating and to decrease fevers.

VD (syphilis, gonorrhea)

A number of men contracted venereal diseases from contact with native women (which was anticipated!).

Calomel (mercurous chloride)

A laxative, this was considered an “alterative” and administered for syphilis, however, ingestion of mercury caused poisoning over time.

Mercury ointment

Used for syphilitic lesions.

Copaiba

A botanical given orally, it soothed lesions from gonorrhea.

Pain, sleep inducer

Opium, laudanum

This was used before morphine was discovered; it was given orally, as hypodermic syringes were not invented at the time.

Wounds, abrasions, bites, boils

Various soothing ointments were concocted for these common injuries and annoyances (think of stepping on a cactus while barefoot). Mosquito and flea bites were abundant. Boils were common with soggy and unsanitary conditions.

Unguent basilicon (hog lard, white resin, yellow wax)

Diachylon plaster (oil and litharge-lead monoxide)

Balsam traumaticum or compound benzoin tincture

Calamine ointment


Irritated eyes

Zinc sulfate (White Vitriol)/lead acetate (Sugar of Lead) eye wash (“eye water”)

This was very common in the native tribes encountered by the Corps (as well as Corp members) whom Lewis and Clark were able to treat with their compounded solutions.

Gastrointestinal maladies

Jalap, rhubarb, calomel, magnesia, Rush’s pills (jalap and calomel; aka “Thunderclappers”)
Laxatives and more laxatives. These were dispensed copiously for the many GI complaints suffered by the expedition members. In times of diminished food supply, a diet low in fiber or in foods not accustomed to, the expedition members suffered greatly from GI issues, including diarrhea, which would not have been helped by laxatives!

Ipecac

Induced vomiting and sweating, both thought to “cure” the body of a variety of illnesses. Ipecac is no longer recommended for poisonings.

Rhubarb (Rheum or China rhubarb)

Not the culinary plant available in grocery stores today, but a botanical used for purging and as a treatment for diarrhea – multipurpose!

Essence of peppermint

For stomach complaints – still in use today in various forms (tea, oil, etc.).

Other Hazards and Conditions

The expeditioners were also exposed to and experienced some common and not so common hazards and conditions during their journey such as animal attacks (rattlesnakes, wolves, buffaloes, bears), trauma from falls off cliffs or horses, water injuries, rheumatism, frostbite, snowblindness, and accidental gunshot wounds (Lewis was shot in the buttocks while hunting).

Childbirth – Sacagawea delivered her son Pomp during the expedition and was given two rings of rattlesnake to aid in the painful labor.

Other Drugs/Botanicals Carried on the Expedition

Glauber’s Salt (“salts”) - laxative, purgative

Cream of Tartar (potassium bitartrate) – laxative

Tartar emetic (potassium antimony tartrate) – to eliminate noxious substances producing imbalance in the patient

Elixir of Vitriol – sulfuric acid/alcohol/aromatics (usually ginger and cinnamon) –a "tonic" and for stomach disorders

Saltpetre (Nitre) – potassium nitrate – produced sweating

Unguentum Epispastic (blistering plaster) from Cantharides (Spanish Flies) – compounded into a base which produced blisters to eliminate disease-causing toxins

Medical Supplies

  • Surgical instruments
  • Dental kit (to extract teeth)
  • Clyster (enema) syringe
  • Penile syringes (lead acetate was injected to sooth the pain of gonorrhea)
  • Lancets for bloodletting
  • Tourniquet (fortunately did not have to be used)
  • Carpenter’s tools for amputations (however, there was nothing to sterilize instruments – this was 80 years into the future)

Additional Reading

The Lewis and Clark Expedition was a stupendous achievement made all the more miraculous in that only one man expired on the journey, a testament to the robust health of the travelers and the leaders’ excellent rudimentary diagnosis abilities and often spot-on medical care. A profuse amount of information exists on the expedition in published books, research papers, exhibitions, parks, the internet or TV; however, it wasn’t until 1980 that a well-researched book was published on the medical aspects of the trip:

Chuinard EG. Only One Man Died: The Medical Aspects of the Lewis and Clark Expedition. Glendale, CA: Arthur Clark Co; 1980

Two other excellent books followed in 2001 and 2002:

Paton B. Lewis and Clark: Doctors in the Wilderness. Golden, CO; Fulcrum Publishing; 2001

Note: a tribute to Dr. Paton was published in Wilderness & Environmental Medicine after his death in 2019.

Peck DJ. Or Perish in the Attempt. Wilderness Medicine in the Lewis and Clark Expedition. Helena, MT: Farcountry Press; 2002

“Modern” day versions of the medications Lewis and Clark may have brought on their expedition. Clockwise from left: bottles of various pills for purging, vomiting, treating fevers or venereal diseases; Plumbi Ac. (lead acetate for use in eye wash); eye wash bottle (something more rudimentary than this was likely used); quinine sulfate (not brought on the trip but later developed for malaria); Tr CinchC (this bottle is tincture; cinchona powdered bark was used on the expedition).
Photo by Nancy Pietroski

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